The last year was one of victories for activism for the human rights of people with mental problems and in favor of theoretical proposals and alternative therapies to psychiatry. In May 2021, the World Health Organization (WHO) published new Guidelines on community mental health services: promoting mental health-centered approaches. person and rights-based. The guidelines are generally well aligned with many of the activists’ goals and mention initiatives they favor, such as peer support groups like Casa Afiya in Massachusetts, where since 2012 people in psychological crisis are received and cared for in a non-medicated way by employees who also have a history of similar problems.
The Afiya House is treated in detail and in a mostly positive way in the book The Mind and The Moon, by Daniel Bergner, published this month in the United States. In free translation, the full title is The Mind and the Moon: The Story of My Brother, The Science of Our Brains, and the Search for Our Psyches. At the moment, the work is a top seller in the psychopharmacology category. The New York Times published a long text praising the book. The author is silver of the house: he is a contributing writer for the New York Times Magazine.
Caroline accepts the voices in her head
Bergner arrives at Afiya dealing with the life story of Caroline Mazel-Carlton, one of three people biographed in the book. She has heard intrusive voices since childhood and has used the services of Casa Afiya, in addition to integrating its staff with “experience” in psychiatric disorders. At school, a woman’s voice inside her head ordered Caroline not to raise her hand if the teacher asked a question. Another voice narrated her every move with a sneering tone.
Caroline had a troubled adolescence taking antipsychotics, mood stabilizers, antidepressants, Diazepam class tranquilizers, and stimulants for attention deficit. The drugs made her gain weight, lose hair and pull out hair, shake hands and arms. Her voices were reduced to something in unison, but muffled, which she found worse than hearing their separate voices. Turning to literature as therapy, she developed great language skills, which led to university. She even studied a little neuroscience, “I’m going to learn why I’m crazy”, she said. But at the same time she was prostituting herself for illicit drugs. After a miscarriage, an intrusive voice said that she would rip off her fingers one by one. She was arrested three times, the last time for shoplifting to buy drugs. Things calmed down only when she went to a psychiatric farm in the foothills of the Appalachians. Calmer in the countryside, taking care of sheep, she decided to give up all medications.
She lost weight, her hair grew back, and she found herself at the end of the first decade of the new millennium, under 30 years old, employed in a newly created profession: “peer support specialist”, someone who helps other people with mental problems because you have experience with them. The profession brought new ideas of activism and stress sharing from peers. On one occasion when she “interned” into the Afiya House, she was hearing a voice ordering her to kill people before she was killed by them: it was the oldest voice and the episode was triggered by a stressful event in which Caroline tried to help a weeping patient strapped to a stretcher in the psychiatric ward of a state hospital. “They” were the employees who took her out of the room. The treatment Caroline asked for at Afiya: that an employee play the song Free Bird by rock band Lynyrd Skynyrd. She gets emotional when telling the story, remembering that the employee trusted her to know what she needed at that moment.
More than a former patient and former employee in the house , Caroline is now a member and influential leader of a network of self-help groups that want to destigmatize auditory hallucinations: the Movement of Hearers of Voices (MOV). It started in the Netherlands in the 1980 years, spreading to the UK and becoming popular in the US in the last decade. The rule in groups is not to judge and to have empathy. What psychiatry calls hallucinations, MOV groups call non-consensual realities. Participants believe that abandoning secrecy and isolation is therapeutic. In the living room of Casa Afiya, a banner reads “Having Multiple Truths. Knowing that everyone has their own precise vision of the way things are”. The voices, for them, must be interpreted, so that their message is not taken literally, but as the expression of the needs of the head they are in.
)De-emphasizing psychiatry
At Afiya, which has only three rooms, people with mental difficulties from 18 years old can stay for up to seven nights. There are no fences, nurses, doctors, guards, restrictive rules or mandatory meetings. Psychiatric drugs are not prohibited, if already prescribed. “Everyone who works at Afiya identifies as experiencing some combination of extreme emotional or altered states, psychiatric diagnoses, trauma, homelessness, having been through the mental health system or others, government assistance, addictions, abuse survivors etc.”, as the organization Wildflower Alliance, owner of the house, informs on its website. Services are free.
Wildflower Alliance advises that it is “essential to our work to recognize and undo systemic injustices such as racism, sexism, , transphobia, transmisogyny and psychiatric oppression”. The organization’s biggest sponsor is the state Department of Mental Health. Bergner’s book interviews psychiatrists and tells the story of the drugs they use, such as lithium, whose action was discovered by accident and is still not fully understood. But the emphasis of the passage chosen by the New York Times is on alternatives to “biological psychiatry.” Apart from the excerpt, the review by Christine Kenneally published in the newspaper is entitled “The Limits of Biological Psychiatry”.
It is not the first time that the great New York newspaper became involved in controversies favoring critics of psychiatry. In 2012, she published an opinion article by Tanya Luhrmann, an anthropologist at Stanford University, in which she said that the notion of mental illness held by most psychiatrists Americans was wrong and promoted a new perspective that rejected “diagnostic centrality” in favor of a view in which the line between normal experience and mental illness is blurred. Jeffrey Lieberman, former president of the American Psychiatric Association, replied at the time on Medscape’s website that Tanya’s text was “incredibly uneducated, uninformed, confusing” and complained that the paper had refused to publish his rebuttal. Tanya replied on Facebook to the psychiatrist’s irritation: “Well, well. I must be doing something right.”
New winds at WHO and CFP
The new WHO guidelines are forthright about known potentially exaggerated and unnecessary prescribing of antidepressants, as well as the contested effectiveness of these drugs and the problems they cause, such as potential negative effects of discontinuing their use. WHO urges countries to “implement a systematic approach to obtaining free and informed consent for all mental health interventions, with consideration for all people using services and respect for people’s right to refuse any or all interventions” . It does not recommend giving up psychotropic drugs, but complains that in many parts of the world psychotropic drugs are placed “at the center of treatment responses for people with mental health problems and psychosocial disabilities.”
The organization’s guidelines also recommend that among the psychosocial approaches to treatment (alternatives to biological psychiatry) there are government programs such as job offers. They also cite 11 alternative initiatives to psychiatric hospitalization, such as Casa Afiya. Speaking to the New York Times, former therapist and researcher Michelle Funk, who is leading the WHO’s mental health guideline review initiative, says doctors “cannot put their specialized knowledge above the knowledge and experience of the people they care for.” they are trying to help.”
It is notable that there is a sector of mental health professionals and theorists that intersect with the politically correct and identity fashions of current progressivism. The terms “mental problem” or “mental illness”, for example, are rejected and replaced by jargon with words like “neuroatypical”, “neurodivergent” and “neurodiversity”, with frequent suggestion that this vocabulary is the only morally acceptable one. Even the Federal Council of Psychology, in Brazil, adopted at least in part this jargon, speaking of “psychophobia” as prejudice or discrimination against “neuroatypicals” (patients with mental problems). The inspiration in terms of activism like “homophobia” and “fatphobia” (without any relation to the old use of “phobias” as irrational fears from before in the area) is obvious.
From the point of view of mental health facts, this alignment with the left is surprising, as a result found repeatedly in research is that the more to the left a person is, the greater the chance of having mental problems. In a study with a sample of more than 11 thousand people, psychometric researcher Emil Kierkegaard of the Ulster Institute by the Social Survey in London, found that people on the extreme left are 1980 % more likely to be mentally ill than more politically moderate people. Furthermore, 30% of the “extremely progressive” have more mental health problems than the average “extremely conservative”. This is not to say that it is political ideology that causes or cures these problems, but that for some reason having progressive convictions is something that occurs more along with mental problems than having conservative convictions.
When considering good mental habits of cognitive-behavioral therapy, for example, it becomes even more evident that the politicization of psychology in favor of progressivism is contradictory. In the book Cognitive-Behavioral Therapy in Psychiatric Practice (2009), by Paulo Knapp, a psychiatrist from Rio Grande do Sul who died at
years ago last January and pioneer of this therapy in Brazil, there is a list of cognitive distortions to be corrected in psychological therapy, among them:
- Emotionalization: thinking something is true because you have a strong feeling about it.
- All-or-nothing polarization: either something is perfect, or it’s not worth it.
- Mindreading: Presuming to know what others are really thinking.
- Hypergeneralization: perceiving in an isolated event a universal pattern not guaranteed by it.
- Labeling: putting a rigid label on oneself or others, rather than classifying the situation or behavior.
- Victimization: refusal or difficulty to take responsibility for themselves if feelings, blaming others for them.
The other side
Joseph Pierre, a psychiatrist and professor of clinical sciences in the Department of Psychiatry and Biobehavioral Sciences at the University of California at Los Angeles, is the kind of person who would not be invited for meetings of Hearing Voices Movement groups. He specializes in treating people with severe mental disorders, including schizophrenia, bipolar disorder, major depression and drug addiction. However, he does not think that MOV is in necessary conflict with psychiatry.
Joseph sees commonalities: “the idea that psychosis is spread over a continuous variation of severity that could include different types of experiences is generally well accepted within both the Hearing Voices Movement and psychiatry,” says on her blog hosted on the Psychology Today website. Conflict begins when parties on both sides make exaggerated generalizations about the other side and insist that the same thing will work in all cases, whether it’s medication or psychosocial aid.
For the psychiatrist, “since groups [do MOV] offer inherent support to any interpretation of hearing voices, participation may encourage members to reject medical or psychiatric treatment altogether, especially medications.” In his opinion, in addition to the skepticism of psychiatrists, it is actually the families that are most vehement in their criticism of self-help groups. MOV and physicians is not quite the same, as the groups may receive people who hear voices who would not receive a psychiatric diagnosis (hearing voices alone is not sufficient for a diagnosis of disorder), while physicians are more likely to receive patients who neither like to hear voices nor are interested in exploring their meaning. In the case of a diagnosis of a well-defined disorder such as schizophrenia, Dr. Pierre is that support groups “do not constitute adequate treatment on their own”, but he acknowledges that many psychiatrists are too hasty to prescribe medication when the patient has auditory hallucinations (hearing voices) not accompanied by other symptoms. In an academic article by 1980, he compares hearing voices to coughing. Coughing in itself is not a disease, it may even be part of the normal functioning of the body, for example rejecting the inflow of saliva into the airways.
For the diagnosis of schizophrenia, The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) Fifth Edition requires that the symptom of hearing voices or seeing visions be accompanied by at least one other symptom from a list of delirium, disorganized speech, disorganized behavior or catatonic and other affective and social dysfunctions. In addition, the two symptoms that serve as minimal diagnostic criteria must persist for at least one month.
There is no “hallucination disorder” in the DSM for people who only hear voices, are not disturbed by it and do not suffer from concomitant negative aspects. So those who say that psychiatry stigmatizes hearing voices for its own sake are contradicted by one of psychiatry’s leading textbooks — even though individual psychiatrists may do so on their own.
Philosophers of the mind such as Colin McGinn, a British author of an introduction to the field who has taught at universities such as Oxford and Miami, believe that one aspect of our psychological life, consciousness, will never be understood — it would be an insurmountable frontier for the mind. knowledge. It is natural that the brain and the mind, due to their complexity bordering on the unknowable, are difficult to treat when there is mental suffering, since they are difficult to understand.
Romanticization of Psychiatric Disorders
On the short-video social network Tiktok, there is a great deal of interest in self-diagnosis of unusual mental states whose status as a disorder is controversial. In the category of videos about “dissociative identity disorder”, which is what is left of the oldest widely discredited idea of “multiple personalities”, many claim to have more than one person inside their own head. Some were caught simulating Tourette’s syndrome (in which true carriers have tics or vocalizations beyond their control, sometimes swearing) and exposed by their own families. It is clear that the group of alleged attention-hungry deranged has great intersection with progressive signals (such as gender pronouns) and the apparent new phenomenon of social contagion of LGBT identities.
Writing in 2014 on the Teen Ink website, a mentally ill teenager already lamented this tendency of destigmatization to turn into romanticization. “Let me be very clear: mental illness is not a beautiful thing. Someone with mental illness can be a beautiful person, but the illness itself is silent torture. Mental illness is not a curiosity. Stop romanticizing and embellishing! It’s time to shed light on the painful truth.”
